Optimal Nutrition for Cancer Survivors

Jessica Iannotta MS, RD, CSO, CDN

What is on your mind?

• Many patients and survivors struggle with weight gain as a result of their treatment

• Often patients are very confused with the wealth of health information– What about soy or dietary supplements?– What is the best diet?– How do I lose weight?

Some important questions to ask…

• Is there a magic bullet or miracle food?

• What can we do to help promote a healthy weight and possibly reduce the risk of cancer recurrence?

American Institute for Cancer Research Guidelines

• Be as lean as possible without becoming underweight.• Be physically active for at least 30 minutes every day.• Avoid sugary drinks. Limit consumption of energy-dense

foods.• Eat more of a variety of vegetables, fruits, whole grains and

legumes such as beans.• Limit consumption of red meats (such as beef, pork and

lamb) and avoid processed meats.• If consumed at all, limit alcoholic drinks to 2 for men and 1

for women a day.• Limit consumption of salty foods and foods processed

with salt (sodium).• Don't use supplements to protect against cancer.

Limit Alcoholic Beverages

• Current research – women who drink one alcoholic beverage per day, may have small increase in risk– Those who drink more may increase their

risk even greater– If estrogen sensitive cancer, use caution

with alcohol

Chen WY, et al. Use of postmenopausal hormones, alcohol, and risk for invasive breast cancer. Ann Intern Med 2002;

137:798-804

Limiting Alcohol Consumption

What is a serving?

-12oz beer

-6oz wine

-1.5 oz hard liquor

• Include folate rich foods in the diet to reduce risk:

– Bananas, oranges, tomatoes– Dark leafy greens– Legumes, lentils– Fortified cereals, whole grain

breads– Supplement 400 micrograms of

folic acid under physician guidance

Include Foods Rich in Folate

Achieve and Maintain a Healthy Weight

• Definition of “Healthy Weight”– Ideal Body Weight +/- 10%– BMI = weight in lbs x 700

height in inches2

BMI = 19-25 “Healthy Weight”

BMI = 26-30 Overweight

BMI > 30 Obese

Apple verses Pear Shape

Apple Shape • A larger distribution of body fat around

the abdomen

Pear Shape• A larger distribution of body fat around

the thighs and hips

Apple shapes may be at higher risk

What does this mean?

• Don’t get too caught up in numbers and shapes

– These formulas do not take into account amounts of lean muscle and physical activity

– BMI and body shape should not be used as sole predictors of someone’s health status

Body Weight and Fat Distribution and Risk of Breast Cancer

The theory is:

Hormones are stored in body fat tissue.

With a greater percentage of body fat, the higher the level of estrogen storage.

These higher estrogen levels may increase the risk of breast cancer.

How to Achieve a Healthy Weight

Higher Fiber• Aim for 25-35 g/day

– Choose mostly whole grains or complex carbohydrates

• Avoid Simple Carbohydrates

– Empty calories

Lower Fat• Choose lean proteins

• Avoid unnecessary added fats

• Choose low fat dairy products

• Be mindful of hidden sources of fat

Sources of Complex Carbohydrates

Grains •Bulgur, Brown Rice, Whole Wheat Pasta, Kasha, Millet

Cereals (aim for >=5g fiber per serving) •Bran Flakes, Kashi, Muesli, Whole oats

Breads (aim for >= 3g fiber per slice) •Whole Wheat, Multi Grain, Rye, Pumpernickel Legumes and Nuts (1-2oz portion or palmful) • Include all types of beans, lentils, variety of unsalted nuts

Lower Fat Intake

• Choose Lean Proteins– Dairy Products

• Choose nonfat/skim milk only• Consume low fat or non fat cheese• Consume low fat or non fat yogurt

– Meats• Choose white meat chicken and turkey, lean

pork• Consume fish 2-3 times per week• Limit red meat intake to less than twice per week

How to Choose the Right Fats

1. Eat more omega-3 fat

• Fish, nuts, seeds, canola oil, flax, fish oil supplementation.

2. Eat some monounsaturated fat

• Olive oil, avocados, canola oil, nuts, seeds

3. Eat less omega-6 fat

• Processed foods like crackers, cookies, chips

4. Eat less saturated fat

• Fast foods, full fat dairy, poultry skin, tropical oils

The Importance of Physical Activity

• Strengthens immune system

• Improves digestion

• Helps control weight or increase weight loss

• Can help decrease hormone levels

• Resistance exercise is also important to increase metabolism

Physical Activity

The American Cancer Society recommends:

150 minutes of moderate physical activity

or

75 minutes of vigorous physical activity

spread throughout the week

Source: American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. January 2012

Benefits of Fruit and Vegetables

Phytochemicals

Naturally found in fruits and vegetables

Help destroy carcinogens in the body before they can damage healthy cells  

Benefits of Fruits and Vegetables

Antioxidants Naturally found in fruits and vegetables

Help protect the body from free radicals

- the dangerous byproducts of some natural metabolic processes in the body, smoking, and exhaust from cars

- Free radicals have shown to play a role as a cancer causing agent

Which are the best to choose?

• All fruits and vegetables contain potential cancer fighting phytonutrients

• Eat a variety with varying colors to ensure you are including the spectrum of phytochemicals and antioxidants your body may need

• Aim for 8 to 10 servings per day • 2-4 fruit servings• 4-7 vegetable servings

Milner JA. J Nutr2004; 134:2492S.

Making Educated Decisions when Choosing Food Supplements and Evaluating Food Trends

Soy and Cancer

• Soy contains phytoestrogens that may compete with estrogen to prevent cancer

• Earlier concerns were that soy could increase cancer recurrence in hormonal breast cancer

• Research to date has demonstrated that in moderate amounts (1-2 servings per day) soy intake from whole soy foods is safe

Phytoestrogens – Noteworthy Observations

• Rates of colon, breast, and prostate cancers are much lower in Asia, where soy is a staple of diet

• Asian women have about one fifth the rate of breast cancer as American women

• Asian women moving to the US develop an increasing incidence of “Western” cancers within 1-2 generations

Could the phytoestrogens in soy products be responsible for these findings?

• Mean daily soy intake 10-50 gm in Asia and 1-3 gm in US

• Estrogen levels are 40% lower in Asian populations

• It may be important at what stage of life the body is exposed to phytoestrogens– During the period of breast development

and adolescence or before the first mutational step in carcinogenesis has occurred.

Breast Cancer Res 2004; 6:119-127

Making the Decision about Soy Foods and other Phytoestrogens

• Discuss with physician or registered dietitian assessing:– Stage of cancer with estrogen

status– Family history– Diet history and prior soy intake– General diet and exercise habits– Weight history– Menopausal status

What is a serving of soy? Choose WHOLE foods

• Soybeans ½ cup• Roasted soybeans ¼ cup• Soy milk 1 cup• Soy yogurt 1 cup• Soy cheese 1 oz• Soy flour ¼ cup• Tempeh ½ cup

• Avoid soy supplements, powders• Limit high sodium processed soy foods

like burgers, nuggets, etc.

GUIDELINES FOR OPTIMAL NUTRITION

Guidelines for Optimal Nutrition

• A cancer fighting and healthy weight loss diet comes down to more than just one food.

• A person’s whole eating pattern is vital for cancer prevention and promotion of healthy weight.

• Don’t make the mistake of focusing on one food to get the job done. – You will be missing out on the great

benefits of all of the others!

A Healthy CANCER-FIGHTING Diet

• Limit alcohol consumption to one or less drink per day

• Maintain a healthy weight by limiting intake of fatty foods especially of animal origin

• Choose whole grains, beans, and legumes to increase fiber intake

• Increase intake of nuts, seeds, and fish to 2-3 times per week.

• Include regular physical activity• Aim for 8-10 servings of vegetables and fruit per

day of varying colors• Make educated decisions when choosing

supplements and evaluating food trends

Thank You!